Agenda 02/28/2017 Item #16E 402/28/2017
EXECUTIVE SUMMARY
Recommendation to ratify Property, Casualty, Workers’ Compensation and Subrogation claim
files settled and/or closed by the Risk Management Division Director pursuant to Resolution #
2004-15 for the first quarter of FY 17.
OBJECTIVE: To settle routine, administrative and minor claims matters which promotes the efficient
use of resources and the efficient administration of the program; and allows for a timely response to
claimants and/or their representatives.
CONSIDERATIONS: Resolution 04-15 grants limited authority to the Risk Management Division
Director to settle certain damage claims against Collier County and to authorize the payment of
investigation and adjustment expenses as presented to the County’s Risk Management Program.
Authority is delegated as follows:
Bodily Injury Liability- Premises, Auto, Operations: Non-litigated claims less than $50,000
Property Damage Liability Claims- Premises, Auto, Operations: Non-litigated claims less than
$75,000
Errors, Omissions, Professional Liability, Employment Practices Liability: Non-litigated claims
less than $50,000
Property Losses to County Owned Property: Full authority
Workers’ Compensation: Full authority subject to the provisions of F.S. 440 and subject to
approval by the Judge of Compensation as needed
Employer’s Liability: Non-litigated claims less than $50,000
Subrogation- Bodily Injury and Property Damage: Full authority to pursue non-litigated
subrogation recoveries
Subrogation- Workers’ Compensation: Full authority to pursue non-litigated subrogation
recoveries
Pursuant to the Resolution, claims are settled and paid according to the loss verification procedures
contained in the Resolution which include the completion of claim forms, documentation of evidence ,
valuation, and the determination of a finding of liability where applicable. Closed claim files are also
subject to review by the external auditor. A listing of claim files closed during the first quarter of FY 17
is attached. The report may include claims and/or settlements previously approved by the Board of
Commissioners as well as litigated files with a final court determination.
FISCAL IMPACT: Funds are budgeted and available in Fund 516-121650-645920 (Property and
Casualty Self Insurance Fund) and 518-121630-645928 (Workers’ Compensation Fund) for the payment
of claims and settlements. For the first quarter of FY 17, 77 files were closed with total expenditures of
$237,376.74. During the same period, 26 subrogation files were closed and the Risk Management
Division recovered $117,702.05 in funds owed the County.
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this
item.
LEGAL CONSIDERATIONS: This item has been reviewed by the County attorney, is approved as to
form and legality, and requires majority vote for approval. -JAK
RECOMMENDATION: To accept the attached Settlement Report and ratify the actions taken therein.
16.E.4
Packet Pg. 983
02/28/2017
Prepared by: Jeff Walker CPCU, ARM, Division Director, Risk Management Division.
ATTACHMENT(S)
1. All Lines Closed Claim Report 1st QTR FY 2017 (PDF)
2. Subrogation Closed Claim Report 1st QTR FY 18 (PDF)
3. Resolution 2004-15 PDF0001 (PDF)
16.E.4
Packet Pg. 984
02/28/2017
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.4
Doc ID: 2678
Item Summary: Recommendation to ratify Property, Casualty, Workers’ Compensation and
Subrogation claim files settled and/or closed by the Risk Management Division Director pursuant to
Resolution # 2004-15 for the first quarter of FY 17.
Meeting Date: 02/28/2017
Prepared by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
01/31/2017 2:56 PM
Submitted by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
01/31/2017 2:56 PM
Approved By:
Review:
Administrative Services Department Michael Cox Level 1 Division Reviewer Completed 01/31/2017 3:47 PM
Administrative Services Department Len Price Level 2 Division Administrator Review Completed 02/14/2017 4:27 PM
Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 02/14/2017 4:42 PM
Office of Management and Budget Laura Wells Additional Reviewer Completed 02/15/2017 8:57 AM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 02/15/2017 10:06 AM
County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 02/19/2017 11:39 AM
Board of County Commissioners MaryJo Brock Meeting Pending 02/28/2017 9:00 AM
16.E.4
Packet Pg. 985
Collier County Government
Closed Claim Report- All Lines
1st QTR FY 2017
Med/BI/Comp Expense Ind/PD/Coll Recovery Deductible Legal Other Total Inc
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Cost Center Date of Loss Date Report to Risk Status Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
Coverage Cause Employer Acc Desc.
Major Coverage: 10 - Workers'
Compensation
1010251605591 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
105010 10/25/2016 10/25/2016 11/7/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1300 Employee tripped over metal door fasteners
in the floor.
1008051605353 684.62 84.00 0.00 0.00 0.00 0.00 0.00 768.62
108010 8/5/2016 8/5/2016 11/29/2016 684.62 84.00 0.00 0.00 0.00 0.00 0.00 768.62
10 1500 Employee was administering a driving test.
The applicant was pulling into a parking
spot and rather than hitting the brake, she
hit the gas. The car jumped the curb and
struck a cement post. Employee is
complaining of back pain.
1010311605573 362.98 0.00 0.00 0.00 0.00 0.00 0.00 362.98
163620 10/31/2016 11/2/2016 11/10/2016 362.98 0.00 0.00 0.00 0.00 0.00 0.00 362.98
10 1300 Employee slipped while exiting sweeper
truck and fell backwards onto the sidewalk.
1010211605554 579.47 14.00 0.00 0.00 0.00 0.00 0.00 593.47
121165 10/21/2016 10/24/2016 10/31/2016 579.47 14.00 0.00 0.00 0.00 0.00 0.00 593.47
10 1200 Employee cut the tip of his left middle finger
off with the box cutter he was using.
1011171605621 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
138910 11/17/2016 11/18/2016 11/28/2016 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 Employee requested medical attention
stating to GMD security officer that he felt
ill, dizzy and lightheaded.
1010281605571 221.53 14.00 0.00 0.00 0.00 0.00 0.00 235.53
144210 10/28/2016 11/1/2016 11/8/2016 221.53 14.00 0.00 0.00 0.00 0.00 0.00 235.53
10 1600 Employee struck his left thigh on the corner
of a desk.
1012281605710 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144610 12/28/2016 12/28/2016 12/31/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1500 Employee strained his back while pulling a
stretcher out of an ambulance.
1011121605605 842.99 0.00 0.00 0.00 0.00 0.00 0.00 842.99
144610 11/12/2016 11/12/2016 11/21/2016 842.99 0.00 0.00 0.00 0.00 0.00 0.00 842.99
10 1500 Employee strained his back when he held
onto a stretcher (with a patient on it) that
was folding.
1
16.E.4.a
Packet Pg. 986 Attachment: All Lines Closed Claim Report 1st QTR FY 2017 (2678 : Recommendation to ratify claims
1012271605708 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
144610 12/27/2016 12/27/2016 12/31/2016 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1500 Employee strained her back while unloading
an obese patient from the back of an
ambulance.
1012201605704 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144610 12/20/2016 12/24/2016 12/31/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1900 Employee suffered an asthma attack after
entering the home of a smoker.
1010181605543 470.53 42.00 0.00 0.00 0.00 0.00 0.00 512.53
138915 10/18/2016 10/19/2016 10/21/2016 470.53 42.00 0.00 0.00 0.00 0.00 0.00 512.53
10 1700 Employee was bit on the left elbow by a
dog as he was walking along a fence.
1012081605669 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
144610 12/8/2016 12/8/2016 12/13/2016 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1700 Stretcher was dropped when being
removed from the back of the ambulance,
and struck the employee's left hand.
1006301605313 8,230.82 294.00 2,957.42 0.00 0.00 0.00 0.00 11,482.24
122410 6/30/2016 7/22/2016 10/31/2016 8,230.82 294.00 2,957.42 0.00 0.00 0.00 0.00 11,482.24
10 1500 Employee's right knee became irritated
following repetative climbing up and down
while repairing a front end loader.
1010211605552 419.70 28.00 0.00 0.00 0.00 0.00 0.00 447.70
233351 10/21/2016 10/21/2016 10/31/2016 419.70 28.00 0.00 0.00 0.00 0.00 0.00 447.70
10 1600 Employee struck his head on a road sign
while trying to get out of the way of an
oncoming vehicle.
1008221605415 74,675.38 378.00 3,227.58 0.00 0.00 0.00 0.00 78,280.96
253211 8/22/2016 8/23/2016 10/28/2016 74,675.38 378.00 3,227.58 0.00 0.00 0.00 0.00 78,280.96
10 1300 Employee slipped and fell on steps.
1010131605545 368.10 28.00 0.00 0.00 0.00 0.00 0.00 396.10
122240 10/13/2016 10/20/2016 10/24/2016 368.10 28.00 0.00 0.00 0.00 0.00 0.00 396.10
10 1600 Employee bumped his left elbow on the
handle of a car door.
1009061605503 235.00 28.00 0.00 0.00 0.00 0.00 0.00 263.00
155410 9/6/2016 9/23/2016 10/12/2016 235.00 28.00 0.00 0.00 0.00 0.00 0.00 263.00
10 1700 Employee was bit on the right thumb by a
cat she was reaching for.
1009061605530 193.52 28.00 0.00 0.00 0.00 0.00 0.00 221.52
155410 9/6/2016 10/13/2016 10/24/2016 193.52 28.00 0.00 0.00 0.00 0.00 0.00 221.52
10 1200 Employee poked her left middle finger with
a needle while trying to draw blood from a
dog.
1011191605651 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144610 11/19/2016 12/1/2016 12/7/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1900 Employee complained of pain in the lower
left portion of her back. There was no
specific incident that caused the pain.
2
16.E.4.a
Packet Pg. 987 Attachment: All Lines Closed Claim Report 1st QTR FY 2017 (2678 : Recommendation to ratify claims
1012011605647 96.00 13.75 0.00 0.00 0.00 0.00 0.00 109.75
144610 12/1/2016 12/1/2016 12/9/2016 96.00 13.75 0.00 0.00 0.00 0.00 0.00 109.75
10 1700 Employee had an insect enter her left eye
while attending a patient in the rear of an
ambulance.
1012191605686 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163620 12/19/2016 12/19/2016 12/31/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1500 Employee complained of lower back pain
after stepping off his truck. He then picked
up a weed wacker and felt increased pain.
1010141605539 314.10 42.00 0.00 0.00 0.00 0.00 0.00 356.10
253212 10/14/2016 10/14/2016 10/21/2016 314.10 42.00 0.00 0.00 0.00 0.00 0.00 356.10
10 1000 Employee burned his left hand on the
exhaust of a Power Valve Operator.
1009141605485 1,958.10 84.00 0.00 0.00 0.00 0.00 0.00 2,042.10
144610 9/14/2016 9/14/2016 12/31/2016 1,958.10 84.00 0.00 0.00 0.00 0.00 0.00 2,042.10
10 1500 Employee hurt his right hip while pulling a
stretcher (with a patient on it) out of the
back of an ambulance.
1009281605513 650.40 56.00 0.00 0.00 0.00 0.00 0.00 706.40
253215 9/28/2016 9/29/2016 10/31/2016 650.40 56.00 0.00 0.00 0.00 0.00 0.00 706.40
10 1700 Employee felt a sharp pain in his lower back
following a vehicle accident where he was
struck from behind.
1010041605518 294.30 42.00 0.00 0.00 0.00 0.00 0.00 336.30
253215 10/4/2016 10/4/2016 10/12/2016 294.30 42.00 0.00 0.00 0.00 0.00 0.00 336.30
10 1600 Employee struck his head and right eye on
a piece of wood protruding from a
dumpster.
90,597.54 1,217.00 6,185.00 0.00 0.00 0.00 0.00 97,999.54
Total by Major Coverage 25 Claims 90,597.54 1,217.00 6,185.00 0.00 0.00 0.00 0.00 97,999.54
3
16.E.4.a
Packet Pg. 988 Attachment: All Lines Closed Claim Report 1st QTR FY 2017 (2678 : Recommendation to ratify claims
Major Coverage: 20 - General Liability
2107031403380 Moya, Mayra 40,000.00 136.05 0.00 0.00 0.00 0.00 0.00 40,136.05
156349 7/3/2014 7/7/2014 10/31/2016 40,000.00 136.05 0.00 0.00 0.00 0.00 0.00 40,136.05
21 2400 Employee was working at Immokalee
Community Park when a woman came up
saying "there's a wire hanging out and
someone got electrocuted". I locked the
building and went outside until the police
and Facilities Management staff arrived.
The BCC approved settlement of this file.
2107061605278 JORDAN, JEFFREY 1,500.00 7.11 0.00 0.00 0.00 0.00 0.00 1,507.11
155410 7/6/2016 7/6/2016 10/17/2016 1,500.00 7.11 0.00 0.00 0.00 0.00 0.00 1,507.11
21 5900 Claimant was meeting with a dog that he
was interested in adopting in the outdoor
play yard; the dog was interacting with the
family when the dog bit his left forearm,
resulting in punctures.
2209021605457 BLANC, SYDNEY 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
210155 9/2/2016 9/6/2016 10/25/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 3100 Claimant alleges the 2 front tires of his low
profile vehicle received egg shaped marks
as a result of roadwork being done in the
area.
2105021605627 RAMOS, RAUDEL 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163647 5/2/2016 11/21/2016 11/30/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 Claimant alleges he was injured when a lid
blew off a County irrigation system.
2208151605408 Michaux, Kimberly 0.00 0.00 604.42 0.00 0.00 0.00 0.00 604.42
253212 8/15/2016 8/19/2016 11/14/2016 0.00 0.00 604.42 0.00 0.00 0.00 0.00 604.42
22 2000 Claimant states while driving through a
maintenance of traffic zone set-up by
Collier County Water Distribution, a sign fell
and struck her vehicle.
2208081605399 Rodriguez, Raquel 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233351 8/8/2016 8/17/2016 10/24/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5100 Customer called in a sewer backup. St.
Crews responded and found roots growing
into clean out. Rehab crew was dispatched
to remove the roots and repair the lateral
and cleanout.
2110031605517 GILLEY, KAREN 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163620 10/3/2016 10/4/2016 12/14/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2050 Claimant was walking on the sidewalk in
front of 650 - 111th Avenue N. when she
tripped and fell. Both hands and knees are
scraped. Right hand is bleeding.
4
16.E.4.a
Packet Pg. 989 Attachment: All Lines Closed Claim Report 1st QTR FY 2017 (2678 : Recommendation to ratify claims
2208221605421 WASKOVICH, CAROLYN 0.00 0.00 596.00 0.00 0.00 0.00 0.00 596.00
233351 8/22/2016 8/24/2016 11/14/2016 0.00 0.00 596.00 0.00 0.00 0.00 0.00 596.00
22 5900 Customer indicated that their plumber found
roots on the CCWSD side of the service
lateral. Wastewater Collections staff
confirmed the presence of tree/plant roots
in the sewer lateral serving the subject
address and replaced the impacted
sections.
2211191605636 Chasse, Linnea 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
122240 11/19/2016 11/23/2016 12/21/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 2000 Saturday afternoon, a woman and her
husband tried to leave the parking garage
through the south exit. When they passed
under the parking barrier, it closed on their
SUV leaving minor damage.
2212181605690 KELLER, SUE 0.00 0.00 375.00 0.00 0.00 0.00 0.00 375.00
156160 12/18/2016 12/19/2016 12/31/2016 0.00 0.00 375.00 0.00 0.00 0.00 0.00 375.00
22 2000 A tree located on the Marco Island Tax
Collector's property dropped a limb onto a
homeowner's lanai.
41,500.00 143.16 1,575.42 0.00 0.00 0.00 0.00 43,218.58
Total by Major Coverage 10 Claims 41,500.00 143.16 1,575.42 0.00 0.00 0.00 0.00 43,218.58
5
16.E.4.a
Packet Pg. 990 Attachment: All Lines Closed Claim Report 1st QTR FY 2017 (2678 : Recommendation to ratify claims
Major Coverage: 30 - Auto Liability
3202231604914 CHUYKO, OLEKSANDR 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233351 2/23/2016 2/29/2016 12/13/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
32 2450 County truck CC2-184 driven by Millard
Taylor proceeded to change lanes, and
struck the rear of a vehicle already
occupying the lane he was moving toward.
3208121605422 REICHART, DAVID 0.00 0.00 5,680.80 0.00 0.00 0.00 0.00 5,680.80
253215 8/12/2016 8/25/2016 10/31/2016 0.00 0.00 5,680.80 0.00 0.00 0.00 0.00 5,680.80
32 2450 Claimant was making a left turn on a green
arrow onto Immokalee Road. A County
employee, driving Asset #CC2-1338, was
making a right turn onto Immokalee Road
(right on red). The employee failed to yield
and struck the claimant's vehicle.
3108191504436 OSMENAJ, ANJEZA 20,000.00 0.00 0.00 0.00 0.00 0.00 0.00 20,000.00
163630 8/19/2015 9/8/2015 11/18/2016 20,000.00 0.00 0.00 0.00 0.00 0.00 0.00 20,000.00
31 3000 Claimant was stopped for a school bus
when she was rear-ended by a County
vehicle.
3203231604994 NIETO, YAJAIRA 0.00 0.00 2,524.07 0.00 0.00 0.00 0.00 2,524.07
138915 3/23/2016 3/24/2016 11/9/2016 0.00 0.00 2,524.07 0.00 0.00 0.00 0.00 2,524.07
32 2450 Our inspector was making a right hand turn
from westbound Vanderbilt to North bound
Livingston Road in the turn lane and our
inspector rear ended the claimants vehicle.
20,000.00 0.00 8,204.87 0.00 0.00 0.00 0.00 28,204.87
Total by Major Coverage 4 Claims 20,000.00 0.00 8,204.87 0.00 0.00 0.00 0.00 28,204.87
6
16.E.4.a
Packet Pg. 991 Attachment: All Lines Closed Claim Report 1st QTR FY 2017 (2678 : Recommendation to ratify claims
Major Coverage: 40 - Auto Physical
Damage
4209141605491 Facilities Management Division 0.00 0.00 1,301.35 0.00 0.00 0.00 0.00 1,301.35
122240 9/14/2016 9/19/2016 12/8/2016 0.00 0.00 1,301.35 0.00 0.00 0.00 0.00 1,301.35
42 5500 On 9/14/16, employee noticed the back
window of truck #050151 was broken and
numerous tools were taken. This happened
between 4:00 pm on 9/13/16 and 6:20 am
on 9/14/16.
4210061605524 Parks & Recreation Division 0.00 0.00 300.96 0.00 0.00 0.00 0.00 300.96
156332 10/6/2016 10/10/2016 10/20/2016 0.00 0.00 300.96 0.00 0.00 0.00 0.00 300.96
42 5900 Staff identified a crack in the windshield
caused by wind.
4109201605498 Road Maintenance Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163620 9/20/2016 9/20/2016 12/9/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3100 Utility trailer # 960068 suffered damaged
when truck # 060064 was backing up with
the trailer attached to it.
4210191605544 Wastewater Division 0.00 0.00 952.40 0.00 0.00 0.00 0.00 952.40
233351 10/19/2016 10/19/2016 11/30/2016 0.00 0.00 952.40 0.00 0.00 0.00 0.00 952.40
42 5900 Fleet management staff observed damage
to the passenger door and passenger
fender of CC2-733 on 10/19/2016. The
cause of the damage is unknown.
4210261605563 Utilities Finance Operations Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
210154 10/26/2016 10/27/2016 12/8/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5900 Employee stopped for fuel and observed
driver's side tail light broken. Employee
does not know when the light was broken
but suspects it may have been when she
stopped at the Circle K Santa Barbara Blvd.
The vehicle was unattended there.
4109201605495 Water Distribution 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
253212 9/20/2016 9/20/2016 10/24/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 While pulled off to the side of Bonita Beach
Road, a vehicle struck the driver's side
mirror of the truck, knocking out the mirror.
4112011605654 Building Review & Permitting Division 0.00 0.00 1,610.48 0.00 0.00 0.00 0.00 1,610.48
138915 12/1/2016 12/2/2016 12/31/2016 0.00 0.00 1,610.48 0.00 0.00 0.00 0.00 1,610.48
41 2000 Asset #CC2-1054 was apparently hit while
employee was inside building doing an
inspection. No fender damage; however,
bumper has some. Also, driver's door
makes sound upon opening it.
4208301605497 Water Distribution Division 0.00 0.00 583.50 0.00 0.00 0.00 0.00 583.50
253212 8/30/2016 9/20/2016 10/13/2016 0.00 0.00 583.50 0.00 0.00 0.00 0.00 583.50
42 5900 Staff discovered damage to their vehicle of
an unknown origin.
7
16.E.4.a
Packet Pg. 992 Attachment: All Lines Closed Claim Report 1st QTR FY 2017 (2678 : Recommendation to ratify claims
4107251605321 Water Division 0.00 0.00 5,987.63 0.00 0.00 0.00 0.00 5,987.63
253212 7/25/2016 7/25/2016 10/13/2016 0.00 0.00 5,987.63 0.00 0.00 0.00 0.00 5,987.63
41 3000 While passing another truck at the South
Water Treatment Plant,employee side
swiped a big rock, causing damage to the
passenger side utility bins.
4109081504470 EMS Division 0.00 0.00 750.82 0.00 0.00 0.00 0.00 750.82
144610 9/8/2015 9/16/2015 12/31/2016 0.00 0.00 750.82 0.00 0.00 0.00 0.00 750.82
41 2450 Truck 18 stopped at intersection for a traffic
light. As the signal turned green, the
flatbed truck ahead of them rolled
backwards before moving forward, striking
the ambulance. EMS crew attempted air
horn warning, but truck did not heed this.
4111081605595 Water Distribution Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
253212 11/8/2016 11/8/2016 11/14/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 While leaving 7-11, employee hit a bollard
and stop sign
4106301605273 Water Division 0.00 0.00 793.10 0.00 0.00 0.00 0.00 793.10
253212 6/30/2016 6/30/2016 10/11/2016 0.00 0.00 793.10 0.00 0.00 0.00 0.00 793.10
41 3000 When employee was attempting to back up
vehicle CC2-644, he bumped into a fire
hydrant. Created a small scratch and dent
on the corner of the rear bumper.
4210281605566 Water Distribution 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
253212 10/28/2016 10/28/2016 11/16/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5900 Staff noticed a gouge in mini U-dump trailer
cargo box. Passenger side front of box.
Unsure who caused the damage.
4111291605644 Solid & Hazardous Waste Management
Division
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
173441 11/29/2016 11/29/2016 12/31/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 2000 Trailer #CC2-1336 was damaged when it
struck the exit fence post at the Naples
Recycling Center. Fender and possibly
axle damage.
4109121605475 Parks & Recreation Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
157710 9/12/2016 9/13/2016 12/20/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 2000 Employee was driving County Van #CC2-
563 to pick up children for our After School
program. Upon his return to the
Community Center, he turned left on
Golden Gate Parkway off Sunshine Blvd.
The right mirror was shattered from hitting a
metal sign.
8
16.E.4.a
Packet Pg. 993 Attachment: All Lines Closed Claim Report 1st QTR FY 2017 (2678 : Recommendation to ratify claims
4109201605496 Road Maintenance Division 0.00 0.00 197.79 0.00 0.00 0.00 0.00 197.79
163620 9/20/2016 9/20/2016 10/13/2016 0.00 0.00 197.79 0.00 0.00 0.00 0.00 197.79
41 3000 Employee was driving truck # 060064
pulling a trailer# 960068 behind, when he
observed something flying off the back of
the truck. At that moment, he stopped &
decided to back up, not remembering that
he had the trailer attached to the truck.
4111031605582 EMS 0.00 0.00 409.50 0.00 0.00 0.00 0.00 409.50
144610 11/3/2016 11/4/2016 11/30/2016 0.00 0.00 409.50 0.00 0.00 0.00 0.00 409.50
41 3000 Employee was turning into station 76 and
misjudged the entrance, striking the curb.
4108171605396 EMS Division 0.00 0.00 3,980.11 0.00 0.00 0.00 0.00 3,980.11
144610 8/17/2016 8/17/2016 10/11/2016 0.00 0.00 3,980.11 0.00 0.00 0.00 0.00 3,980.11
41 2450 Medic 46 (Truck #8) struck Brush Truck
#46 in the bay at Station 46 while trying to
manauver through the bay to their parking
spot. No employees injured.
4211041605586 EMS 0.00 0.00 391.93 0.00 0.00 0.00 0.00 391.93
144610 11/4/2016 11/5/2016 11/18/2016 0.00 0.00 391.93 0.00 0.00 0.00 0.00 391.93
42 2000 While driving on Immokalee Rd, a rock was
thrown up from vehicle in front on
ambulance, striking the windshield.
4111081605603 Facilities Management Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
122240 11/8/2016 11/10/2016 11/16/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 Vehicle 050146 while backing up, the
ladder on its ladder rack struck the ladder
rack on the vehicle behind it damaging the
other vehicles ladder and ladder rack.
4111161605612 Bureau of Emergency Services Division 0.00 0.00 1,812.35 0.00 0.00 0.00 0.00 1,812.35
144210 11/16/2016 11/16/2016 12/6/2016 0.00 0.00 1,812.35 0.00 0.00 0.00 0.00 1,812.35
41 3000 Employee was attempting to pull into the
front driveway circle of her workplace and
struck the curbing which caused her foot to
fall off the brake and onto the gas. The
vehicle jumped the curb and struck a light
post.
4110251605559 Transportation Engineering & Construction
Management Division
0.00 0.00 1,970.27 0.00 0.00 0.00 0.00 1,970.27
TECM 10/25/2016 10/25/2016 11/29/2016 0.00 0.00 1,970.27 0.00 0.00 0.00 0.00 1,970.27
41 2000 While Traveling north on County Barn
Road, employee was taking a right turn into
back entrance at Avalon just south of Davis
Blvd . While turning, he glanced to his left
briefly and hit fire hydrant with right front
bumper/front.
4110101605523 Solid & Hazardous Waste Management
Division
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
SOWE 10/10/2016 10/10/2016 10/12/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 2000 Mirror flipped back and broke when truck
touched pole on exiting the parking garage.
9
16.E.4.a
Packet Pg. 994 Attachment: All Lines Closed Claim Report 1st QTR FY 2017 (2678 : Recommendation to ratify claims
4108121605381 Water Distribution Division 0.00 0.00 2,039.63 0.00 0.00 0.00 0.00 2,039.63
253215 8/12/2016 8/12/2016 10/20/2016 0.00 0.00 2,039.63 0.00 0.00 0.00 0.00 2,039.63
41 2450 Employee in Vehicle CC2-1338 was making
a right hand turn onto Immokalee Rd (right
on red). The other vehicle was making a
left hand turn on a green arrow onto
Immokalee Road. Employee failed to yield
and struck the other vehicle.
4111081605594 Water Distribution Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
253212 11/8/2016 11/8/2016 11/14/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 While leaving a site restoration at 7-11,
employee hit a bollard and a stop sign
causing damage to the truck and trailer.
The bollard lost some paint and the stop
sign post was twisted.
4110211605549 Wastewater Division 0.00 0.00 1,626.30 0.00 0.00 0.00 0.00 1,626.30
233351 10/21/2016 10/21/2016 11/29/2016 0.00 0.00 1,626.30 0.00 0.00 0.00 0.00 1,626.30
41 2000 When driving south on 951, a vehicle in
front of me hit a broken muffler that was in
the road and pushed the muffler into my
lane of travel.Employee struck it on the
driver's side front wheel.
4108081605362 Water Distribution 0.00 0.00 520.10 0.00 0.00 0.00 0.00 520.10
253212 8/8/2016 8/9/2016 10/20/2016 0.00 0.00 520.10 0.00 0.00 0.00 0.00 520.10
41 3100 While turning around at 6575 Whitaker
Road, County truck #CC2-1337 jack knifed
trailer CC2-1097 denting the lift motor box
for the trailer.
4207071605286 Water Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
253212 7/7/2016 7/7/2016 11/30/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5900 While completing walk around, employee
noticed that the right rear lens was cracked.
4206241605271 Transportation Engineering & Construction
Management Division
0.00 0.00 518.90 0.00 0.00 0.00 0.00 518.90
163611 6/24/2016 6/30/2016 10/31/2016 0.00 0.00 518.90 0.00 0.00 0.00 0.00 518.90
42 5900 Found a dent in the tailgate of this truck. It
is unknown how it occurred.
4109211605525 Water Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
253212 9/21/2016 10/10/2016 10/21/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 2000 While driving through the SRO a branch
struck passenger mirror breaking it.
4108261605424 Traffic Operations Division 0.00 0.00 3,419.81 0.00 0.00 0.00 0.00 3,419.81
163630 8/26/2016 8/26/2016 12/19/2016 0.00 0.00 3,419.81 0.00 0.00 0.00 0.00 3,419.81
41 3000 Two County vehicles were parked next to
each other discussing the next location for
work. Vehicle #060021 had the drivers side
door open. Vehicle #CC2-906 pulled away
and caught the drivers door of vehicle
#060021 with the cones on the back.
4110101605534 Pelican Bay Services Division 0.00 0.00 1,142.99 0.00 0.00 0.00 0.00 1,142.99
182901 10/10/2016 10/14/2016 10/31/2016 0.00 0.00 1,142.99 0.00 0.00 0.00 0.00 1,142.99
41 3000 Trailer was not properly attached to the
County vehicle & caused a dent on the
tailgate of the vehicle, above the license
plate.
0.00 0.00 30,309.92 0.00 0.00 0.00 0.00 30,309.92
Total by Major Coverage 32 Claims 0.00 0.00 30,309.92 0.00 0.00 0.00 0.00 30,309.92
10
16.E.4.a
Packet Pg. 995 Attachment: All Lines Closed Claim Report 1st QTR FY 2017 (2678 : Recommendation to ratify claims
Major Coverage: 50 - Property
5604211605619 Airport Authority Division 0.00 0.00 10,218.62 0.00 0.00 0.00 0.00 10,218.62
192330 4/21/2016 11/18/2016 12/31/2016 0.00 0.00 10,218.62 0.00 0.00 0.00 0.00 10,218.62
56 2150 Employee encountered a saturated marsh
(unknown at time). The Bobcat sank upon
entering the marsh. The Bobcat sunk to the
level of the enclosed cab. As a result of
pressure being applied to the cab door, the
door and cab frame were damaged.
5609061605452 Solid & Hazardous Waste Management
Division
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
173435 9/6/2016 9/6/2016 10/21/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
56 2000 Back window of Kubota broken during
loading of bed.
5301231604801 Pelican Bay Services Division 22,943.00 0.00 0.00 0.00 0.00 0.00 0.00 22,943.00
PBSE 1/23/2016 1/27/2016 12/6/2016 22,943.00 0.00 0.00 0.00 0.00 0.00 0.00 22,943.00
53 5400 Frame has broken off a plant shade cover.
Some of the legs broke off - this was a
result of high winds from the storm that
passed through the area.
5606091605209 Capital Construction & Maintenance
Operations Division
0.00 0.00 313.01 0.00 0.00 0.00 0.00 313.01
163628 6/9/2016 6/10/2016 12/31/2016 0.00 0.00 313.01 0.00 0.00 0.00 0.00 313.01
56 5900 Broke window on right side of John Deere
dozer # 060115
5604111605087 Coastal Zone Management Division 0.00 0.00 3,792.63 0.00 0.00 0.00 0.00 3,792.63
110407 4/11/2016 4/26/2016 10/31/2016 0.00 0.00 3,792.63 0.00 0.00 0.00 0.00 3,792.63
56 5000 While operating the Kobota (#CC2-671) on
the beach to pick up trash, the beach
equipment operator was flagged down by a
patron & informed that the unit was on fire.
He brought the unit to a hault & put the
flame out wtih a hand held fire extinguisher.
5109191605494 Bayshore Gateway Triangle CRA 376.57 0.00 0.00 0.00 0.00 0.00 0.00 376.57
138325 9/19/2016 9/20/2016 10/31/2016 376.57 0.00 0.00 0.00 0.00 0.00 0.00 376.57
51 2350 Shirley Garcia reported that vagrants threw
a brick through a window and tore the soffit
from the roof on the 1965 Tamiami Trail E.
building.
Total by Major Coverage 6 Claims 23,319.57 0.00 14,324.26 0.00 0.00 0.00 0.00 37,643.83
Grand Totals: 77 Claims 175,417.11 1,360.16 60,599.47 0.00 0.00 0.00 0.00 237,376.74
1/27/2017
1:35:32 PM
11
16.E.4.a
Packet Pg. 996 Attachment: All Lines Closed Claim Report 1st QTR FY 2017 (2678 : Recommendation to ratify claims
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2017
Valued as of:1/23/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
0.00 0.00 0.00 0.00 1,500.00 0.00 0.00 0.00CC v. Young, Samuel5306111605262
10/19/20166/11/2016 6/28/2016 0.00 0.00 0.00 1,500.00 0.00 0.00 0.00 0.00110409
53 Samuel Young was traveling the
waterway through Caxambas
Pass and was not paying
attention. His vessel was
heading towards a channel
marker and attempted to turn
right at the last second, but
struck the channel marker.
3000
6,886.95 0.00 0.00 0.00 7,386.95 6,886.95 0.00 0.00CC v. Morca Const. Services,
Inc. ($7,386.95)
4104221605076
11/21/20164/22/2016 4/22/2016 0.00 6,886.95 0.00 7,386.95 6,886.95 0.00 0.00 0.00144610
41 M90 (Tk 14) was stopped at red
light at Collier Blvd and Capri
Blvd, when a 4 door SUV
heading south bound collided
head -on with rear end of 4 door
pickup. SUV flipped over onto its
roof and the truck spun and
slammed into the side of M90.
3000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CC v. BLINN, GARY5405091605122
10/7/20165/9/2016 5/10/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00156363
54 Mr. Blinn was in parking space
with several dogs. Distracted, he
hit the gas, vehicle jumped
parking stop and curb,
compressed some bushes,
struck a tree and broke off a
sprinkler head. NO INJURIES.
3000
882.90 0.00 0.00 0.00 982.90 0.00 0.00 882.90CC v. EQ Florida, Inc./U.S.
Ecology ($982.90)
5310161504529
11/29/201610/16/2015 10/16/2015 882.90 0.00 0.00 982.90 882.90 0.00 0.00 0.00173441
53 A vendor collided with the
structure of the manual exit gate.
The damage prevents the gate
from closing and securing
properly.
3000
0.00 0.00 0.00 0.00 1,405.36 0.00 0.00 0.00CC v. Century Link ($1,873.81)5303221605013
12/5/20163/22/2016 3/30/2016 0.00 0.00 0.00 1,405.36 0.00 0.00 0.00 0.00233351
-1-
10:03:45AM
1/23/2017
16.E.4.b
Packet Pg. 997 Attachment: Subrogation Closed Claim Report 1st QTR FY 18 (2678 : Recommendation to ratify claims
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2017
Valued as of:1/23/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
53 Century Link bore through a
County lateral line while
performing a line bore.
2000
0.00 0.00 0.00 0.00 28,131.24 0.00 0.00 0.00CC v. Accurate Drilling Systems,
Inc. ($28,131.24)
5306081605390
10/4/20166/8/2016 8/16/2016 0.00 0.00 0.00 28,131.24 0.00 0.00 0.00 0.00233313
53 Accurate Drilling Systems, who
is working for Summit
Broadband, bored through an
18" reclaimed water main at Trail
Blvd. and Gulf Park Drive.
2000
0.00 0.00 0.00 0.00 6,128.37 0.00 0.00 0.00CC v. Raw Construction
($6,128.37)
5305311605195
10/27/20165/31/2016 6/6/2016 0.00 0.00 0.00 6,128.37 0.00 0.00 0.00 0.00162525
53 Ronald Coleman was backing
north on Bayshore Drive just
south of Weeks Avenue for well
drilling maintenance and struck a
light pole.
3000
0.00 0.00 0.00 0.00 351.64 0.00 0.00 0.00CC v. MacGonigle, Matthew
($553.01)
5302101604919
10/27/20162/10/2016 3/1/2016 0.00 0.00 0.00 351.64 0.00 0.00 0.00 0.00163630
53 Andria Crummett was traveling
north on Golden Gate Parkway
and entered into the intersection
of Livingston Road on a red light
and struck another vehicle,
causing that vehicle to strike a
street sign.
3000
0.00 0.00 0.00 0.00 17,577.07 0.00 0.00 0.00CC v. Rivera, Jeanne
($17,577.07)
5305201605239
10/14/20165/20/2016 6/22/2016 0.00 0.00 0.00 17,577.07 0.00 0.00 0.00 0.00163620
53 Heriberto Rivera Otano was
traveling north on Santa Barbara
Blvd. when he struck the rear of
another vehicle, causing it to to
overturn on the roadway.
2450
0.00 0.00 0.00 0.00 927.78 0.00 0.00 0.00CC v. Medina, Edamis
($927.78)
5907131605416
10/14/20167/13/2016 8/23/2016 0.00 0.00 0.00 927.78 0.00 0.00 0.00 0.00163620
-2-
10:03:45AM
1/23/2017
16.E.4.b
Packet Pg. 998 Attachment: Subrogation Closed Claim Report 1st QTR FY 18 (2678 : Recommendation to ratify claims
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2017
Valued as of:1/23/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
59 Edamis Medina was traveling
north on Corkscrew Road in a
dump truck loaded with gravel.
The right front wheel traveled off
the roadway, he swerved then
overturned, gouging the road &
spilling the gravel on the
roadway.
3100
0.00 0.00 0.00 0.00 6,318.70 0.00 0.00 0.00CC v. Rupert, Michelle5308311605500
10/14/20168/31/2016 9/21/2016 0.00 0.00 0.00 6,318.70 0.00 0.00 0.00 0.00163620
53 Osvaldo Serrano was traveling
north on Everglades Blvd. in a
reckless manner & attemped to
make a right turn to head east
on Immokalee Road, but skidded
and struck a guardrail.
3000
0.00 0.00 0.00 0.00 751.73 0.00 0.00 0.00CC v. Francois, Steeve5302161605357
10/14/20162/16/2016 8/8/2016 0.00 0.00 0.00 751.73 0.00 0.00 0.00 0.00253212
53 Steeve Francois made a right
turn out of Whistlers Cove
apartment complex and due to
wet road conditions, slid all over
the road and struck another
vehicle, then an Air Release
Valve (ARV).
3000
23,527.70 0.00 0.00 0.00 23,809.50 23,390.30 137.40 0.00CC v. MORGAN, DARIN
TERRILL (23,809.50)
4106141605214
11/30/20166/14/2016 6/14/2016 0.00 23,390.30 137.40 23,809.50 23,527.70 0.00 0.00 0.00163630
41 Street light crew were out on NB
Collier Blvd. just north of Lord's
Way with MOT set up. They
were starting to remove the MOT
when they noticed a car coming
toward the MOT. Voice comand
for everyone to move. Car struck
#CC2-1000. No employees in
truck.
2450
0.00 0.00 0.00 0.00 7,328.94 0.00 0.00 0.00CC v. Morales, Jessica
($7,328.94)
5307251605423
10/4/20167/25/2016 8/25/2016 0.00 0.00 0.00 7,328.94 0.00 0.00 0.00 0.00163620
-3-
10:03:45AM
1/23/2017
16.E.4.b
Packet Pg. 999 Attachment: Subrogation Closed Claim Report 1st QTR FY 18 (2678 : Recommendation to ratify claims
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2017
Valued as of:1/23/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
53 Jessica Morales was traveling
north on Collier Blvd. when her
windows fogged up and as she
tried to clean them, she lost
control of the vehicle, striking a
guardrail.
3000
0.00 0.00 0.00 0.00 164.00 0.00 0.00 0.00CC v. Vanpelt, Howard5307251605355
11/16/20167/25/2016 8/5/2016 0.00 0.00 0.00 164.00 0.00 0.00 0.00 0.00163630
53 Howard Vanpelt was traveling
south on Rattlesnake-Hammock
Road when the driver's side tire
blew, causing him to lose control
of the vehicle. He drove onto the
median and struck 2 traffic
signs.
3000
0.00 0.00 0.00 0.00 1,955.00 0.00 0.00 0.00CC v. Santoro, Jason
($2,055.00)
5405161605456
10/18/20165/16/2016 9/6/2016 0.00 0.00 0.00 1,955.00 0.00 0.00 0.00 0.00163801
54 Jason Santoro was traveling
west on Tamiami Trail E. at 91
MPH. He saw that Law
Enforcement was behind him
trying to pull him over. He
suddenly tried to turn off the
roadway, but lost control of the
vehicle and struck landscaping &
irrigation.
3000
0.00 0.00 0.00 0.00 805.41 0.00 0.00 0.00CC v. Cross, Mary5308291605536
11/23/20168/29/2016 10/14/2016 0.00 0.00 0.00 805.41 0.00 0.00 0.00 0.00163620
53 Mary Cross was traveling south
on Palm River Blvd. when her
vehicle left the roadway and
struck a bridge railing.
3000
1,192.90 0.00 0.00 0.00 1,294.60 1,192.90 0.00 0.00CC v. Kurylak, Kyle ($1,294.60)4110171605542
12/5/201610/17/2016 10/18/2016 0.00 1,192.90 0.00 1,294.60 1,192.90 0.00 0.00 0.00210154
41 Mr. Kurylak backed into
#CC2-267 while it was parked
and unoccupied in my driveway
at 291 2nd St SE for on call
purposes.
3000
-4-
10:03:45AM
1/23/2017
16.E.4.b
Packet Pg. 1000 Attachment: Subrogation Closed Claim Report 1st QTR FY 18 (2678 : Recommendation to ratify claims
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2017
Valued as of:1/23/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
0.00 0.00 0.00 0.00 276.48 0.00 0.00 0.00CC v. Siefert, Julia5301201604798
11/21/20161/20/2016 1/26/2016 0.00 0.00 0.00 276.48 0.00 0.00 0.00 0.00163630
53 Julia Siefert was traveling north
on Tamiami Trail in the left turn
lane at 99th Ave. N. violating the
right of way of another vehicle
causing a collision. Her vehicle
rotated clockwise, skidded &
struck a pedestrian signal & a
fire hydrant.
3000
0.00 0.00 0.00 0.00 389.31 0.00 0.00 0.00CC v. Sowers, Thomas5108151605387
11/21/20168/15/2016 8/15/2016 0.00 0.00 0.00 389.31 0.00 0.00 0.00 0.00192350
51 Cessna Caravan taxiing from
runway to parking, struck
decking support beam with
portside wing causing severe
structural damage to deck. FAA
Flight Standards District Office
(FSDO) notified and will conduct
investigation.
3000
0.00 0.00 0.00 0.00 1,030.00 0.00 0.00 0.00CC v. Wilson, Bruce ($1,030.00)5404221605365
10/17/20164/22/2016 8/9/2016 0.00 0.00 0.00 1,030.00 0.00 0.00 0.00 0.00163652
54 Bruce Wilson was stopped at the
red light on Palm River Blvd.
when he made a right on red,
crossing several lanes of traffic.
He ran onto the median striking
a tree and 3 Crown of Thorn
bushes.
3000
0.00 0.00 0.00 0.00 235.00 0.00 0.00 0.00CC v. Johnson-Jones, Daphne
($235.00)
5406081605388
10/31/20166/8/2016 8/15/2016 0.00 0.00 0.00 235.00 0.00 0.00 0.00 0.00163652
54 Daphne Johnson-Jones was
traveling north on Airport Road
when she reached over to
remove a bag from the front
passenger seat and the vehicle
jumped the curb and struck
landscaping in the median.
3000
-5-
10:03:45AM
1/23/2017
16.E.4.b
Packet Pg. 1001 Attachment: Subrogation Closed Claim Report 1st QTR FY 18 (2678 : Recommendation to ratify claims
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2017
Valued as of:1/23/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
1,802.29 0.00 0.00 0.00 1,848.61 1,802.29 0.00 0.00CC v. Harden, Selena4108121605379
10/14/20168/12/2016 8/12/2016 0.00 1,802.29 0.00 1,848.61 1,802.29 0.00 0.00 0.00173441
41 A dump truck traveling south on
I-75 (mile marker 134)
rear-ended a blue Ford Edge
causing loss of control and
struck County Asset #CC2-1332.
2450
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CC v. Weeks, Casey5412121403792
10/17/201612/12/2014 1/8/2015 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00163652
54 Casey Weeks was traveling
south on US41 when he lost
control of his vehicle before a
curve and struck a tree.
3000
6,653.25 0.00 0.00 0.00 6,553.25 6,653.25 0.00 0.00CC v. BAZLEY, MELISSA
($6,653.25)
4109171605490
12/20/20169/17/2016 9/19/2016 0.00 6,653.25 0.00 6,553.25 6,653.25 0.00 0.00 0.00253215
41 While stopped at a light at
Oscela Drive and Pine Ridge
Road, County vehicle
#CC2-1074 was struck from
behind.
2450
0.00 0.00 0.00 0.00 550.21 0.00 0.00 0.00CC v. GARCIA, Madelyn4108171605570
11/29/20168/17/2016 11/1/2016 0.00 0.00 0.00 550.21 0.00 0.00 0.00 0.00233315
41 County vehicle was struck in the
rear by another driver
2450
882.90
882.90
137.40
137.40
39,925.69
39,925.69
117,702.05
117,702.05 0.00
0.00 0.00
0.00
0.00
0.00
40,945.99
40,945.99Grand Totals: 26 Claims
-6-
10:03:45AM
1/23/2017
16.E.4.b
Packet Pg. 1002 Attachment: Subrogation Closed Claim Report 1st QTR FY 18 (2678 : Recommendation to ratify claims
16.E.4.c
Packet Pg. 1003 Attachment: Resolution 2004-15 PDF0001 (2678 : Recommendation to ratify claims files closed for 1st QTR of FY 17 by the Risk Management Director)
16.E.4.c
Packet Pg. 1004 Attachment: Resolution 2004-15 PDF0001 (2678 : Recommendation to ratify claims files closed for 1st QTR of FY 17 by the Risk Management Director)
16.E.4.c
Packet Pg. 1005 Attachment: Resolution 2004-15 PDF0001 (2678 : Recommendation to ratify claims files closed for 1st QTR of FY 17 by the Risk Management Director)
16.E.4.c
Packet Pg. 1006 Attachment: Resolution 2004-15 PDF0001 (2678 : Recommendation to ratify claims files closed for 1st QTR of FY 17 by the Risk Management Director)
16.E.4.c
Packet Pg. 1007 Attachment: Resolution 2004-15 PDF0001 (2678 : Recommendation to ratify claims files closed for 1st QTR of FY 17 by the Risk Management Director)
16.E.4.c
Packet Pg. 1008 Attachment: Resolution 2004-15 PDF0001 (2678 : Recommendation to ratify claims files closed for 1st QTR of FY 17 by the Risk Management Director)